Drug Overdose Deaths,
Hospitalizations,
and Emergency
Department Visits
in Kentucky,
2000 - 2012
Kentucky Injury Preven on and Research Center
Drug Overdose Deaths, Hospitaliza ons,
and Emergency Department Visits
in Kentucky, 2000‐2012
January, 2014 Prepared by Svetla Slavova, PhD
Terry L. Bunn, PhD
Joshua W. Lambert, MS
Released by Kentucky Injury Preven on and Research Center (KIPRC) 333 Waller Avenue, Suite 242 Lexington, Kentucky 40504 For more informa on contact Svetla Slavova E‐mail: ssslav2@email.uky.edu Table of Contents:
Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Drug overdose deaths, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Drug overdose hospitalizations, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Drug overdose emergency department visits, 2008‐2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Medicaid recipient opiate overdose hospitalizations and emergency department visits. . . 27 Opioid‐related disease condition hospitalizations, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . .32 Neonatal abstinence syndrome hospitalizations, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . . .37 Appendix A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 About this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 1 Execu ve Summary
1. The total number of Kentucky resident drug overdose deaths leveled off from 2011 to 2012 (1,022 deaths in 2011 and 1,031 deaths in 2012). 2. The Kentucky resident age‐adjusted drug overdose mortality rate decreased from 24.2 in 2011 to 23.9 in 2012 (1.2% decrease). 3. Pharmaceu cal opioids remained the primary cause of Kentucky resident drug overdose deaths in 2012; pharmaceu cal opioids accounted for 471 drug overdose deaths. 4. Heroin contributed to 129 Kentucky resident drug overdose deaths in 2012, a 207% increase from the 42 heroin‐involved deaths recorded in 2011. 5. Benzodiazepines contributed to 362 Kentucky resident overdose deaths in 2012, decreasing 16% from 2011. 6. Kentucky age‐adjusted drug overdose hospitaliza on rates decreased 2.4% from 2011 to 2012, from 146.6 hospitaliza ons/100,000 popula on in 2011 to 143.1 in 2012. 7. Intent to self‐harm was the primary reason for 2012 Kentucky resident inpa ent hospitaliza ons, simi‐
lar to years 2000‐2011. 8. Benzodiazepines were the primary drugs involved in Kentucky resident inpa ent hospitaliza ons in 2012 decreasing 11% to 1,686 hospitaliza ons in 2012. 9. Pharmaceu cal opioids were the second leading drug type involved in drug overdose related hospitali‐
za ons in 2012, decreasing 8% from 1,610 hospitaliza ons in 2011 to 1,483 in 2012. 10. Total charges for drug overdose hospitaliza ons rose 7% from $121.1 million in 2011 to $129.3 million in 2012. 11. The primary expected payer source for Kentucky resident drug overdose inpa ent hospitaliza ons was Medicare followed by Medicaid for 2011 and 2012; Medicare was billed $41.3 million and Medicaid was billed $34.1 million in 2012. 12. Casey, Carroll, Nicholas, Powell, and Johnson coun es had the highest Kentucky resident drug over‐
dose emergency department (ED) visit rates, 2008‐2012. 2 Execu ve Summary (cont’d)
13. Kentucky resident drug overdose ED visit numbers and rates leveled off in 2012 from 6,496 visits and an age‐adjusted rate of 153.1 visits/100,000 popula on in 2011 to 6,492 visits and an age‐adjusted rate of 153.0 in 2012. 14. Kentucky resident drug overdose ED visit charges increased 5% from $14.6 million in 2011 to $15.3 mil‐
lion in 2012. 15. Self‐pays were the primary payer billed for drug overdose ED admissions in 2012 at $5 million; Medi‐
caid was billed $4.2 million and commercial insurance was billed $3.6 million. 16. Benzodiazepines were the primary drugs involved in Kentucky drug overdose ED visits in 2012 with 856 visits; pharmaceu cal opioid involvement decreased 6% to 721 visits in 2012. 17. Heroin involvement in drug overdose related ED visits increased 197% from 266 ED visits in 2011 to 789 visits in 2012. 18. Medicaid recipient total drug overdose ED charges totaled $740,000 in 2012, a 27% increase from a total of $584,000 charged in 2011. 19. Medicaid recipient total drug overdose inpa ent hospitaliza on charges totaled $11 million in 2012, approximately the same as in 2011. 20. Kentucky resident opioid‐related disease condi on hospitaliza on charges totaled $167 million in 2012; Medicaid was billed for $55 million. 21. There were 824 Kentucky resident neonatal abs nence syndrome hospitaliza ons. Associated charges amounted to $40 million; Medicaid was charged $35 million. 22. Of the 9,713 pharmaceu cal opioid or heroin related hospitaliza ons in 2012, viral hepa
s was co‐
diagnosed for 1,653 (17%) of them with associated charges of $37 million. 23. There were 1,192 hospitaliza ons involving opioid drug dependence and viral hepa
increase over the 976 hospitaliza ons in 2011. 3 s in 2012, a 22% Drug Overdose
Deaths
2000‐2012
4 Kentucky Resident Drug Overdose Deaths, 2000‐2012
1200
1000
Total Number
800
711
673
747
746
2008
2009
996
1,022
1,031
2010
2011
2012
621
600
551
525
2003
2004
435
400
339
246
200
0
2000
2001
2002
2005
2006
2007
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
Kentucky Resident Age‐Adjusted Drug Overdose Mortality Rates, 2000‐2012
Mortality Rate (# Deaths /100,000 Population)
30
25
23.3
24.2
23.9
2010
2011
2012
20
16.9
14.8
15
13.4
17.4
17.3
2008
2009
15.8
12.7
10.6
10
8.3
6.1
5
0
2000
2001
2002
2003
2004
2005
2006
2007
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
5 Kentucky Resident Drug Overdose Deaths by Gender, 2000‐2012
622
613
614
700
287
409
382
409
444
303
238
268
220
203
Male
Female
158
132
161
206
228
300
200
322
276
322
400
84
Total Number
400
435
443
500
459
600
100
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
Kentucky Resident Age‐Adjusted Drug Overdose Mortality Rates by Gender,
2000‐2012
18.5
19.1
17.6
13.1
13.8
Female
11.0
12.4
10.4
29.2
28.9
21.6
21.3
20.6
19.4
15.7
Male
7.6
6.4
8.0
10.2
10.8
15
9.7
13.7
15.8
20
5
21.5
25
4.0
Mortality Rate (# Deaths/100,000 Population)
30
10
29.3
35
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
6 874
912
1000
900
911
Kentucky Resident Drug Overdose Deaths by Intent, 2000‐2012
800
612
620
546
590
533
265
400
300
Self Harm
355
500
Unintentional
443
472
600
204
Total Number
700
Undetermined
62
58
50
59
55
67
56
78
60
67
67
60
65
54
47
41
46
34
45
33
48
26
9
33
100
59
20
200
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
20.8
20.9
20.1
25
14.2
14.5
12.8
12.7
Unintentional
10.7
11.5
15
14.0
20
8.7
Self Harm
Undetermined
5.0
6.5
10
1.4
1.3
1.1
1.4
1.3
1.5
1.3
1.8
1.4
1.6
1.6
1.4
1.5
1.3
1.1
1.0
1.1
0.8
1.1
0.8
1.4
0.5
1.2
0.6
5
0.8
0.2
Crude Mortality Rate (# Deaths/100,000 Population)
Kentucky Resident Crude Drug Overdose Mortality Rates by Intent,
2000‐2012
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
7 8 Opiates/opioids Heroin Pharmaceutical Opioids Methadone Cocaine Other and unspecified narcotics Drugs not elsewhere classified or
unspecified
Nonopioid analgesics
Antiepileptic, sedative‐hypnotic, anti‐
Parkinsonism, antidepressant, and other psychotropic drugs, not elsewhere classified. Benzodiazepines Narcotics and psychodysleptics not
elsewhere classified
149 0 149 73 30 22 222
173
193 1
192 116 27
23
284
218
229
188
T40(.0‐.4) T40.1 T40.0, T40(.2‐.4)
T40.3 T40.5 T40.6 T50.9
T50.9 Only
29
45 T42.4 T36‐T38.9, T40(.0‐.9),
T41, T44, T45(.0‐.4),
T45(.6‐.9), T46‐T50.8
25
87
16
87 190 0 190 118 32 26 284
205
231
31 23
78 239
0 239
136
53
28
327
233
300
41
28
84
248 1 247 126 48 15 274
222
296
23 33
51 243
0 243
106
36
14
281
221
282
33
27
64
265 4 262 89 36 17 279
232
299
54 36
93 285 14 271 53 15 22 273
215
312
84 9
98 480
34
449
96
31
30
606
289
522
279
7
307
568
42 538
95 25 79 793
307
656
430
7
467
569 129 471 76 50 89 796
299
677
362 8
405 Year
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
T39
T42, T43 Kentucky Resident Drug Overdose Deaths by Contributing Drugs
Contributing Drug
ICD‐10 code
9 Occurrences of Specific Drugs among the Contributing Causes for
Kentucky Resident Drug Overdose Deaths, 2011‐2012
15
24
Hydromorphone
20
16
Tramadol
34
Fentanyl
Clonazepam
Cocaine
25
54
2012
50
54
2011
50
64
Diazepam
Morphine
52
78
66
66
Oxymorphone
90
76
Methadone
Heroin
92
129
42
173
Hydrocodone
203
188
Oxycodone
257
205
Alprazolam
0
50
100
150
Total Number
200
276
250
300
Produced by the Kentucky Injury Prevention and Research Center, November 2013. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
10 11 Drug Overdose
Hospitaliza ons
2000‐2012
12 Kentucky Resident Drug Overdose Hospitalizations, 2000‐2012
7,000
6,000
4,963
5,000
Total Number
4,024
4,312
4,531
4,626
4,524
2002
2003
2004
2005
5,244
5,320
2007
2008
5,626
5,749
2009
2010
6,422
6,296
2011
2012
4,000
3,372
3,000
2,000
1,000
0
2000
2001
2006
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Age‐Adjusted Rate (# hospitalizations/ 100,000
population)
160
Kentucky Resident Age‐Adjusted Drug Overdose Hospitalization Rates,
2000‐2012
146.6
140
117.6
120
98.4
100
105.1
110
111.6
2002
2003
2004
123.3
124
2007
2008
129.7
132.1
2009
2010
143.1
108.1
82.6
80
60
40
20
0
2000
2001
2005
2006
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
13 1,933
2003
2004
2005
2,619
2,688
2,410
3,290
2,336
3,147
2,173
3,100
2,836
2,144
1,909
2,127
2,591
2,678
1,853
1,724
1,581
2,000
1,500
2,588
2,443
1,989
2,500
1,383
Total Number
3,000
2,717
3,500
3,339
4,000
3,677
3,734
Kentucky Resident Drug Overdose Hospitalizations by Gender, 2000‐2012
Male
Female
1,000
500
0
2000
2001
2002
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
163.6
167.3
121.8
125.6
113.7
150
148.9
110.8
104.1
121.5
131.8
102.7
2004
103.3
2003
94.8
127.2
123.1
94.4
80
91.9
100
79.6
95
120
86.5
116.7
140
128.8
160
143.2
143.3
180
69.7
Hospitalization Rate (#hospitalizations/ 100,000 population)
Kentucky Resident Age‐Adjusted Drug Overdose Hospitalization Rates
by Gender, 2000‐2012
Male
Female
60
40
20
0
2000
2001
2002
2005
2006
2007
2008
2009
2010
2011
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
14 2012
2,642
2,221
2,252
1,018
445
1,014
441
409
2,530
333
407
719
823
1,691
726
1,497
665
558
1,404
610
549
1,955
1,999
2,497
2,566
2,521
2,398
2,186
1,271
560
569
542
525
1,080
1,147
2,281
2,254
486
523
536
561
957
987
500
751
1,000
509
660
1,738
1,500
404
477
Total Number
2,000
2,027
2,500
2,346
3,000
2,708
Kentucky Resident Drug Overdose Hospitalizations by Intent, 2000‐2012
0
2,000
2,001
2,002
2,003
2,004
Unintentional
2,005
2,006
Self Harm
2,007
Undetermined
2,008
2,009
2,010
2,011
2,012
No Ecode
45.0
50.7
51.5
60.3
62.0
58.2
57.9
59.8
23.2
23.2
10.2
16.7
18.9
10.1
9.3
10.0
9.4
7.8
16.9
39.4
15.6
13.1
35.2
14.5
13.0
13.0
12.6
30.4
13.5
13.7
27.7
26.2
12.4
16.0
11.9
12.9
10.0
11.8
13.1
13.7
23.4
24.3
30.0
33.3
40.0
20.0
59.2
56.8
42.9
50.0
46.3
49.8
60.0
52.3
55.4
55.1
70.0
56.6
Kentucky Resident Drug Overdose Hospitalization Rates by Intent ,
2000‐2012
18.5
Hospitalization Rate (# hospitalizations/100,000 population)
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
0.0
2000
2001
2002
Unintentional
2003
2004
Self/Harm
2005
2006
2007
Undetermined
2008
2009
2010
2011
No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
15 2012
16 Other Unspecified
Anticoagulants
Psychostimulants Benzodiazepines Antidepressants
Cocaine
Methadone Pharmaceutical Opioids Heroin Opiates/opioids
4‐Aminophenol
Nonopioid analgesics
DRUG
ICD‐
9‐CM
Codes
For ICD‐9‐CM codes see Appendix A
Kentucky Resident Drug
Overdose Related
Hospitalizations
Drug Type
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
118
67
509
10
112
147
577
16
591
404
714
73
184
658
21
677
414
723
75
206
718
14
731
430
740
81
163
717
11
728
438
731
85
215
921
41
957
562
830
587 875
608
906
546
826
587 880
496 793
39 62
48
62 170 93
226 72
201 81
190
104
189
213
194 217
168 961 1,030 1,201 1,254 1,610 1,483 30 988 1,065 1,259 1,298 1,668 1,637
571 877
67
93
74
93
90
96
110
107
90
106
90
102
106
94 110
84 125
111
135
112
80
203 77
180 1,755 1,972 2,190 2,198 2,231 2,212 2,489 2,546 2,769 2,845 3,009 3,369 3,410
87
63 793 1,120 1,181 1,181 1,245 1,196 1,386 1,511 1,561 1,661 1,645 1,885 1,686 1,781 2,275 2,389 2,487 2,529 2,461 2,667 2,849 2,973 3,032 3,044 3,479 3,250
90
31 332 8 519
379
351 339
644
590
3,372 4,024 4,312 4,531 4,626 4,524 4,963 5,244 5,320 5,626 5,749 6,422 6,296
2000
Year
Total Charges for Drug Overdose Hospitalizations, 2000‐2012
$140.0
$129.3
$121.1
$120.0
$100.0
Dollars (in millions)
$87.8
$93.0
$77.4
$80.0
$69.3
$61.3
$60.0
$43.8
$40.0
$48.2
$50.6
$33.7
$21.1
$26.2
$20.0
$0.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Drug Overdose Hospitalizations by Total Length of Stay, 2000‐2012
25,000
21,594 21,344
20,000
17,802 17,832
19,004 18,664
15,839
Total Days of Hospital Stay
15,000
13,768
15,061
14,635 14,285
12,367
10,385
10,000
5,000
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
17 Kentucky Resident Drug Overdose Hospitalizations by Expected Payer,
2000‐2012
2,000
1,800
1,600
Total Number
1,400
1,200
1,000
800
600
400
200
0
2000
2001
2002
2003
Commercial
2004
2005
Medicaid
2006
Medicare
2007
2008
Other
2009
2010
2011
2012
Self Pay or Charity
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Kentucky Resident Total Drug Overdose Hospitalization Charges
by Expected Payer, 2000‐2012
$45
$40
$35
Dollars (in millions)
$30
$25
$20
$15
$10
$5
$0
2000
2001
2002
2003
Commercial
2004
2005
Medicaid
2006
Medicare
2007
Other
2008
2009
2010
2011
Self Pay or Charity
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
18 2012
19 Drug Overdose
Emergency Department Visits
2008‐2012
20 Kentucky Resident Drug Overdose Emergency Department Visits,
2008‐2012
7,000
6,000
5,917
5,778
2009
2010
6,496
6,492
2011
2012
5,414
Total Number
5,000
4,000
3,000
2,000
1,000
0
2008
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Age‐adjusted rate (# ED visits/ 100,000 population) Kentucky Resident Age‐Adjusted Drug Overdose Emergency Department
Visit Rates, 2008‐2012
170
150
130
139.5
136.5
2009
2010
129.4
153.1
153.0
2011
2012
110
90
70
50
30
10
‐10
2008
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
21 Kentucky Resident Drug Overdose Emergency Department Visits
by Gender, 2008‐2012
3,479
3,024
3,017
3,120
2,658
2,659
2,362
Total Number
3,000
2,500
3,258
3,052
3,500
3,468
4,000
2,000
Male
1,500
Female
1,000
500
0
2008
2009
2010
2011
2012
Kentucky Resident Age‐Adjusted Drug Overdose Emergency Department
Visit Rates by Gender, 2008‐2012
120
163.1
142.6
142.4
147
125.7
125.9
140
145
160
153.3
180
163.2
200
113.5
Age‐adjusted rate (# ED visits/100,000 population)
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
100
Male
80
Female
60
40
20
0
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
22 Kentucky Resident Drug Overdose Emergency Department Visits by Intent,
2008‐2012
3,157
1,092
490
596
599
900
690
869
634
766
1,500
1,000
1,547
1,084
1,642
1,742
1,715
1,646
2,608
2,289
Total Number
3,000
2,000
2,629
3,500
2,500
3,354
4,000
500
0
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Unintentional
Self Harm
Undetermined
No Ecode
72.3
24.9
35.3
24.7
11.2
13.7
13.7
20.6
16.0
14.8
20
17.9
30
20.1
40
37.7
37.8
40.4
40.0
50
60.5
70
60.6
80
60
76.6
90
53.4
Crude rate (# ED visits/100,000 population)
Kentucky Resident Crude Drug Overdose Emergency Department Visit
Rates by Intent, 2008‐2012
10
0
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Unintentional
Self Harm
23 Undetermined
No Ecode
Kentucky Resident Total Drug Overdose Emergency Department Visit
Charges, 2008‐2012
$18
$16
$15.3
$14.6
$14
Dollars (in millions)
$12.0
$11.4
$12
$9.4
$10
$8
$6
$4
$2
$0
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
$5.0
$6
Kentucky Resident Total Drug Overdose Emergency Department Visit
Charges by Expected Payer, 2008‐2012
$1.8
$2.3
$2.5
$3.6
$4.2
$4.3
$3.8
$3.7
$0.3
$0.3
$0.2
$0.3
$3.1
$3.2
$1.7
$0.3
$1
$3.3
$2.9
$3.4
$1.9
$2
$1.5
$3
$2.9
$2.8
Dollars (in millions)
$4
$3.6
$5
$0
2008
2009
Commercial
2010
Medicaid
Medicare
2011
Other
2012
Self Pay or Charity
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
24 Kentucky Resident Drug Overdose Related ED Visits
2008
5,414
2009
5,917
Year 2010
5,778
Nonopioid analgesics, Antipyretics, and Antirheumatics
805
831
776
764
737
4‐Aminophenol derivatives 428
462 418
420
379
590
725
816
73
142 211
266
789
518
585 614
769
721
54
48 52
43
58
42
37
45
67
88
2,033
2,179
2,075
804
907 866
939
856
133
143 140
199
172
65
104
88
57
54
3,195
3,500
3,455
For ICD‐9‐CM codes see Appendix A
DRUG Involved
Opiates/opioids
Heroin Pharmaceutical Opioids Methadone Cocaine
Antidepressants, barbiturates and other antiepileptics,
sedative‐ hypnotics, and psychotropic drugs not elsewhere
classified
Benzodiazepines Psychostimulants with abuse potential including methamphetamine, MDMA (Ecstasy) Anticoagulants
Other specified and unspecified drugs
2011 2012
6,496 6,492
1,026 1,488
2,320 2,200
3,864 3,651
Kentucky Resident Drug Overdose Emergency Department Visits by Drugs
Involved, 2008‐2012
518
721
789
856
614
585
700
‐100
2008
Benzodiazepine
2009
2010
Pharmaceutical Opioids
88
45
67
211
37
42
142
300
100
266
500
73
Total Number
939
769
804
900
866
907
1,100
2011
Heroin
2012
Cocaine
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
25 26 Medicaid Recipient
Opiate Overdose
Hospitaliza ons and
Emergency Department Visits
27 Medicaid Recipient Opiate Overdose Hospitalizations
by Gender, 2000‐2012
280
350
2004
148
128
2007
Female
102
128
188
55
2003
90
80
51
2002
Male
153
139
2006
90
83
52
2001
70
75
80
41
2000
100
112
121
150
137
200
50
198
250
32
42
Total Number
254
300
0
2005
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Medicaid Recipient Opiate Overdose Hospitalizations
by Intent, 2000‐2012
191
250
173
101
110
92
104
61
73
64
87
83
96
74
63
24
15
12
15
25
20
45
29
19
17
76
77
61
59
72
47
49
64
59
36
46
45
23
17
17
38
46
33
16
13
49
43
100
50
136
138
150
18
28
15
13
Total Number
200
0
2,000
2,001
2,002
2,003
Unintentional
2,004
2,005
Self Harm
2,006
2,007
Undetermined
2,008
2,009
2,010
2,011
No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
28 2,012
Medicaid Recipient Total Opiate Overdose Inpatient Hospitalization Charges,
2008‐2012
$12
$11.4 $11.1 $10
$8
Dollars (in millions)
Total Charges
$6.7 Operating Room Charges
Other Charges
$6
Oncology Charges
$5.6 Pharmacy Charges
Radiology Charges
Room & Board Charges
Labor & Delivery Charges
$4.1 Anesthesia Charges
$4
Ancillary Charges
$2
$0
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
29 Medicaid Recipient Opiate Overdose Emergency Department Visits by
Gender, 2008‐2012
146
160
101
77
89
94
100
63
71
80
60
Male
53
Total Number
120
108
114
140
Female
40
20
0
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Medicaid Recipient Opiate Overdose Emergency Department Visits
by Intent, 2008‐2012
136
160
140
101
120
12
27
35
40
55
56
71
73
52
38
36
8
7
7
20
7
40
33
60
68
80
54
Total Number
100
0
2008
2009
Unintentional
2010
Self Harm
Undetermined
2011
2012
No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
30 Medicaid Recipient Opiate Overdose Total Emergency Department
Charges, 2008‐2012
$900
$800
$740
$700
$584
Dollars (in thousands)
$600
$472
$500
$405
$400
$306
$300
$200
$100
$0
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
31 Opioid‐Related
Disease Condi on
Hospitaliza ons
2000‐2012
32 Kentucky Resident Opioid‐Related Disease Condition Hospitalizations,
2000‐2012
9,000
8,465
7,891
8,000
7,389
6,909
7,000
6,400
Total Number
6,000
5,464
5,725
4,677
5,000
4,385
4,000
3,142
3,357
3,860
3,000
2,209
2,000
1,000
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Note: 6.7% of all opioid‐related disease condi on hospitaliza ons listed also an ICD‐9‐CM code for drug overdose 2008
5,757
5,572
5,220
4,578
4,356
2007
2010
2011
2,005
1,850
2006
1,771
2005
1,661
890
2004
1,358
828
2003
1,193
787
2002
1,158
2,707
658
2001
2,000
1,124
3,564
2,673
481
2000
3,000
1,000
3,083
4,000
3,795
5,000
361
Total Number
6,000
6,147
7,000
6,491
Kentucky Resident Opioid‐Related Disease Condition Hospitalizations
by Condition Type, 2000‐2012
0
Nondependent opioid abuse
2009
Opioid type drug dependence
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Note: 0.3% of all opioid‐related disease condi on hospitaliza ons listed both condi on types 33 2012
4,610
Kentucky Resident Opioid‐Related Disease Condition Hospitalizations
by Gender, 2000‐2012
1,216
993
2,000
1,500
2001
2002
3,855
3,711
3,678
3,231
3,168
2,890
2,835
2,770
2,694
2,241
2,144
1,793
1,564
2,500
2,013
1,847
3,000
2,355
2,322
3,500
1,718
1,424
Total Number
4,000
3,430
3,479
4,500
3,803
4,088
5,000
Male
Female
1,000
500
0
2000
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Kentucky Resident Opioid‐Related Disease Condition Hospitalization
Charges, 2000‐2012
$180.0
$166.6
$160.0
$144.1
Dollars (in millions)
$140.0
$122.1
$120.0
$104.0
$100.0
$84.5
$80.0
$62.1
$60.0
$48.6
$40.0
$21.6
$20.0
$66.1
$27.7
$34.7
2002
2003
$41.6
$13.9
$0.0
2000
2001
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
34 Kentucky Resident Opioid‐Related Disease Condition Hospitalization
Charges by Expected Payer, 2000‐2012
$45.9
$2.9
2012
$39.6
$55.4
$22.8
$41.4
$1.2
2011
$31.3
$49.3
$20.8
$37.3
$2.0
2010
$23.7
$41.4
$17.7
$30.3
$1.4
2009
$21.7
$36.9
$13.8
$20.5
$17.0
$17.3
$2.7
2008
$15.0
$13.2
$6.3
2007
$22.7
$8.8
$6.9
2006
$12.7
$12.8
$10.3
$10.0
$8.2
$9.8
$5.6
2005
$8.7
$5.5
$7.8
$5.2
2004
$27.0
$19.4
$15.0
Self Pay or Charity
$14.4
Other
Medicare
$6.0
$3.5
$6.8
$10.8
$7.5
2003
$3.8
$2.2
$5.2
2002
Medicaid
Commercial
$8.3
$8.3
$3.3
$2.3
$4.2
$6.7
$5.2
$1.2
$1.0
$2.5
$5.0
$4.1
2001
2000
$0.0
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
Dollars (in millions)
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
35 $70.0
Kentucky Resident Hospitalizations Involving
Opioid Drug Overdose or an Opioid‐Related Disease Condition
AND
Viral Hepatitis,
2000‐2012
2012
144
2011
2004
65
43
2003
59
34
35
20
2001
29
20
2000
24
8
0
277
89
33
2002
Year
394
113
56
2005
435
108
45
2006
545
135
53
2007
633
157
85
2008
702
208
85
2009
976
293
114
2010
1,192
378
210
Opioid type drug dependence & Viral hepatitis
203
Nondependent opioid abuse & Viral hepatitis
138
Drug overdoses due to the effect of opiates and
related narcotics &Viral hepatitis
118
72
200
400
600
800
1,000
1,200
Total Number
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
36 Neonatal Abs nence
Syndrome
Hospitaliza ons
2000‐2012
37 Kentucky Resident Neonatal Abstinence Syndrome Hospitalizations,
2000‐2012
900
824
800
678
700
Total Number
600
485
500
435
400
329
275
300
227
200
100
28
62
93
128
2002
2003
166
175
0
2000
2001
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Kentucky Resident Neonatal Abstinence Syndrome Hospitalization
Charges, 2000‐2012
$45.0
$40.2
$40.0
$36.0
$35.0
Dollars (in millions)
$30.0
$23.8
$25.0
$25.0
$20.0
$15.0
$15.0
$10.0
$7.5
$5.0
$0.2
$1.5
$1.3
$2.4
$3.2
2001
2002
2003
2004
$4.0
$5.2
$0.0
2000
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
38 Kentucky Resident Neonatal Abstinence Syndrome Hospitalizations by Expected Payer, 2000‐2012 Self‐Pay or Commercial Medicaid Other Charity 2000 5
20
<5
<5 2001 16
41
<5
<5 2002 11
67
8
7 2003 21
99
<5
<5 2004 14
139
<5
9 2005 12
147
7
9 Year 2006 11
202
9
5 2007 23
224
16
12 2008 37
270
18
<5 2009 38
355
40
<5 2010 42
402
35
6 2011 90
526
55
7 2012 59
694
54
17 Note: Counts less than 5 were suppressed by state data management policy. Kentucky Resident Neonatal Abstinence Syndrome Hospitalization Charges by Expected Payer, 2000‐2012 Self‐Pay or Commercial Medicaid Other Total Charity 2000 $75,463 $155,642
$4,318
$1,074 $235,423
2001 $989,491 $464,827
$11,180
$20,927 $1,465,498
2002 $181,443 $932,251
$24,374 $113,947 $1,138,068
2003 $685,212 $1,597,333
$9,166 $145,842 $2,291,710
2004 $262,538 $2,731,983
$50,125 $189,625 $3,044,646
2005 $471,640 $3,201,153
$46,089 $276,770 $3,718,883
2006 $161,693 $4,802,755
$138,686 $134,258 $5,103,135
Year 2007 $697,463 $6,001,220
$414,598 $355,295 $7,113,281
2008 $2,700,471 $11,503,166
$685,389
$96,154 $14,889,026
2009 $3,142,217 $19,266,407 $1,198,435 $227,639 $23,607,058
2010 $2,156,244 $21,052,317 $1,231,209 $580,403 $24,439,769
2011 $6,360,864 $28,130,564 $1,267,251 $232,167 $35,758,679
2012 $3,287,661 $34,876,300 $1,606,756 $476,472 $39,770,716
39 APPENDIX A
ICD‐9‐CM codes for acute poisonings due to the effects of drugs (drug overdoses)
ICD‐9‐CM codes Type of Poison DRUG E850‐E585, E950(.0‐.5), E962.0, E980(.0‐.5), 960‐979 E850(.3‐.8), 965(.1‐.8) ‐Nonopioid analgesics, Antipyretics, and Antirheumatics ‐‐4‐Aminophenol derivatives E850.4, 965.4 ‐Opiates/opioids E850(.0‐.2), 965.0 ‐‐Heroin E850.0, 965.01 ‐‐Pharmaceutical Opioids E850(.1‐.2), 965(.00,.02‐.09) ‐‐‐Methadone E850.1,965.02 ‐Cocaine E854.3, E855.2, 968.5, 970.81 E851‐E853, E854(.0‐.2,.8), E855.0, E950(.1‐.3), E980(.1‐.3), 966, 967, 969, 970(.0,.1,.89) ‐Antidepressants, barbiturates and other antiepileptics, sedative‐hypnotics, and psychotropic drugs not elsewhere classified ‐‐Benzodiazepines E853.2, 969.4 ‐‐Psychostimulants with abuse potential including methamphetamine, MDMA (Ecstasy) E854.2, 969.7 ‐Anticoagulants 964.2 ‐Other specified and unspecified drugs E850(.9), E855(.1,.3‐.9), E856‐E858, E950(.0,.4,.5), E962.0, E980(.0,.4,.5), 960‐963, 964(.0,.1,.3‐.9), 965.9, 968(.0‐.4,.6‐.9), 970(.9),971‐979, For more informa on, please refer to: Consensus Recommenda ons for Na onal and State Poisoning Surveillance, Safe States, April 2012. 40 Conclusions
The combina on of mul ple preven on approaches such as mandatory enrollment and use of the Kentucky All Schedule Prescrip on Electronic Repor ng system by prescribers and dispensers, physician ownership of pain clinics, prescriber guidelines for pain treatment, and increased law enforcement resulted in substan al decreases in Kentucky resident prescrip on drug overdose deaths, inpa ent hospitaliza ons, and ED admissions from 2011 to 2012. With that said, pharmaceu cal opioids remained the primary drugs involved in drug overdose deaths; benzodiazepines were the primary drugs involved in drug overdose‐related inpa ent hospitaliza‐
ons and ED visits. Pharmaceu cal opioid involvement decreased 12% for drug overdose deaths, 8% for in‐
pa ent hospitaliza ons, and 6% for ED visits from 2011‐2012. Correspondingly, benzodiazepine involve‐
ment decreased 16% for drug overdose deaths, 11% for inpa ent hospitaliza ons, and 9% for ED visits from 2011‐2012. Raising awareness of the dangers of mixing benzodiazepines with opioids should be an empha‐
sis of physician con nuing educa on for relaying to opioid pa ents during medical consulta ons. While the contribu on of prescrip on opioids and benzodiazepines to drug overdoses decreased from 2011 to 2012, there was a precipitous increase in heroin involvement in drug overdose deaths, inpa‐
ent hospitaliza ons, and ED visits over the same me period. Heroin involvement increased 207% for drug overdose deaths, 174% for inpa ent hospitaliza ons, and 197% for ED visits. Opioid‐related hospitaliza ons and ED visits are costly in more than only financial erms. Disease condi ons already present or those caused by opiate addic on such as viral hepa s also exert an enormous societal as well as financial toll on the commonwealth’s popula on. Increased law enforcement, adjudica on, legisla on, and heroin abuse treat‐
ment should be a major priority for Kentucky to reduce heroin‐related deaths, and hospitaliza ons. Total inpa ent hospitaliza on charges for drug overdoses rose 7% in 2012 to $129.3 million. Like‐
wise, drug overdose ED charges rose 5% to $15.3 million in 2012. The primary expected payers for drug overdose related inpa ent hospitaliza ons were Medicare ($41.3 million) and Medicaid ($34.1 million). Self
‐pays were the largest expected payer for drug overdose ED visits ($5 million) followed by Medicaid ($4.2 million). Medicaid recipient opiate overdose ED charges increased 27% in 2012 to $740,000. Inpa ent hospi‐
taliza ons of Medicaid recipients for opiate overdoses leveled off in 2012 at $11 million. Elevated Medicaid charges illustrate the need for naloxone (an opiate an dote) reimbursement by Medicaid so that Medicaid recipients are not charged for its purchase. Intranasal administra on of naloxone during an opiate overdose has been credited with saving countless lives. A mul pronged strategy to reduce substance abuse in the Commonwealth of Kentucky involves the basic elements of the public health model that includes comprehensive surveillance and tracking of drug overdoses, iden fica on of the risk factors that result in drug overdoses, development of interven ons to prevent drug overdoses, and the widespread adop on of substance abuse preven on interven ons. In ad‐
di on, increased con nuing educa on of physicians on drug abuse and treatment, increased law enforce‐
ment, increased adjudica on, and increased substance abuse treatment facili es are necessary to decrease the extraordinary toll of substance abuse on Kentucky ci zens who are addicted. 41 About This Report
This report presents drug overdose morbidity and mortality data for Kentucky residents, using mul ple data sources: ‐ Kentucky Death Cer ficate Files, Kentucky Office of Vital Sta s cs, 2000‐2012 (data captured as of October 21, 2013). The 2009‐2012 files are provisional and subject to change. ‐ Kentucky Inpa ent Hospitaliza on (IH) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, 2000‐2012 (data for 2010‐2012 are provisional and subject to change). ‐ Kentucky Emergency Department (ED) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, 2008‐2012 (data for 2010‐2012 are provisional and subject to change). Drug overdose mortality and morbidity case selec on was based on opera onal defini ons of acute
drug poisoning (also called “drug overdose”) by the Injury Surveillance Workgroup on Poisoning (ISW7) in their Consensus RecommendaƟons for NaƟonal and State Poisoning Surveillance, The Safe States Alliance,
Atlanta, GA, April 2012.1 Drug Overdose Deaths:
Each death cer ficate contains one underlying cause of death and mul ple contribu ng causes of death. The underlying cause of death is defined as the reason that ini ated the chain of events leading di‐
rectly to death. The underlying and contribu ng causes of death are coded according to the Interna onal Classifica on of Diseases, 10th revision (ICD‐10) [www.who.int/classifica ons/icd10/]. Defini on: Drug overdose deaths were iden fied as deaths with an underlying cause of death in the follow‐
ing range: X40‐X44(accidental/uninten onal drug poisoning), X60‐X64(suicide by drug poisoning), X85
(homicide by drug poisoning), and Y10‐Y14 (drug poisoning with undetermined intent). The types of drugs contribu ng to drug overdose deaths were iden fied using ICD‐10 codes T36‐
T50.9 listed in any of the mul ple causes of death fields. Contribu ng drugs were reported in standardized categories, following the ISW7 Poisoning Matrix for ICD‐10 Coded Mortality Data.1 Drug Overdose Hospitaliza ons and ED Visits :
IH and ED data were coded according to the Interna onal Classifica on of Disease, 9th revision, Clini‐
cal Modifica on (ICD‐9‐CM, www.icd9cm.chrisendres.com). The ICD‐9‐CM system describes an injury using diagnosis codes and E‐codes. The Kentucky IH and ED data systems include up to 25 diagnosis code fields per case. The first diagnosis code is called the principal diagnosis code. The principal diagnosis for a hospitalized pa ent is the main reason for the pa ent’s hospital stay and is based on the clinical findings during the pa‐
ent’s stay. For ED data, the primary diagnosis code is the diagnosis established to be the main reason for the visit to the emergency department. Other condi ons/diagnoses that exist at the me of the IH/ED visit and affect the diagnosis, treatment, or length of stay in the health facility, are also coded in the remaining 24 diagnosis code fields in the IH/ED datasets and are called secondary diagnoses. Injury diagnoses should be supplemented (when circumstances of the injury are known) with addi onal codes called E‐codes. E‐codes are separated into three groups: external‐cause‐of‐injury codes, place‐of‐injury codes, and ac vity codes. 42 The external‐cause‐of‐injury code describes the external cause (in this case, poisoning) and the in‐
tent of injury. Based on the external‐cause‐of‐injury code, a drug poisoning can be classified by intent as accidental (uninten onal, E850‐E858), inten onal (self‐harm, E950.0‐E950.5; or assault, E962.0), or unde‐
termined (E980.0‐E980.5 when based on insufficient documenta on in the medical chart to determine whether the drug overdose was accidental or inten onal). Some injury records in the IH or ED datasets, however, are not supplemented with E‐codes at all. We treat such records as a separate category and refer to them as “missing intent” or “no E‐code”. IH and ED electronic records may contain up to three designat‐
ed E‐code fields. On average, more than 90 percent of the Kentucky HD and ED cases with poisoning diag‐
noses are supplemented with valid external‐cause‐of‐injury codes. Defini on: A hospitaliza on or emergency department visit was considered a drug overdose if 1) any of the ICD‐9‐CM codes in the range 960‐979 were listed in any diagnosis (principal or secondary) fields; or 2) any of the ICD‐9‐CM codes in the range E850‐E858, E950.0‐E950.5, E962.0, or E980.0‐E980.5 were listed in the E‐code fields. This Injury Surveillance Workgroup on Poisoning1 defini on is a broader defini on than the defini‐
on used in the 2012 report2 on drug overdose morbidity and mortality in Kentucky. Therefore, if compar‐
ing the morbidity sec ons in the current and in the 2012 report, one will no ce about a 30% increase in the reported cases of drug overdose hospitaliza ons or ED visits. The 2012 report was based on defini ons de‐
rived from the external‐cause‐of‐injury matrix and didn’t capture encounters of care where the principal diagnosis was not a drug overdose but the secondary diagnosis was drug overdose. A study on drug over‐
dose ED visits in the U.S. suggested that mild or moderate drug overdoses were likely to have the drug poisoning as their primary diagnosis but severe drug poisoning cases were likely to have a cri cal illness as the primary diagnosis.3 Severe drug overdoses can result in acute respiratory, heart, or renal failure that may be listed as principal diagnoses with a drug overdose listed as the secondary diagnosis. As the state enacts policies and plans for adequate substance abuse treatment resources, the most comprehensive defi‐
ni on to track and enumerate total drug overdose hospitaliza ons and ED visits was used to provide a more accurate picture of the magnitude of substance abuse and misuse, the specific drugs involved, and the specific popula ons at higher risk for drug overdoses. Only records for KY residents treated in Kentucky acute care hospitals or Kentucky emergency de‐
partments are included in this report. Data for Kentucky residents treated in neighboring states were not available and not included in this report. Therefore, the presented counts and rates likely underes mate the full extent of drug overdoses in Kentucky. Reported frequencies reflect the number of visits/
hospitaliza ons since follow‐up visits and readmissions for one and the same drug overdose could not be iden fied. Age‐adjusted morbidity and mortality rates were based on 2000 U.S. standard popula on data. For each of the three data sets, the number of cases classified as assault was low (48 ED visits from 2008 –
2012, 35 hospitaliza ons from 2000 –2012 and seven fatali es from 2000 –2012) and were not included in the figures or discussed in this report. A sec on on mental disorder hospitaliza ons involving opiates/opioids was included in the report in order to describe disease condi ons induced by opium, heroin, and/or opioid analgesics. The case selec on followed the ISW71 framework and included hospitaliza ons related to opioid type dependence, drug de‐
pendence on combina ons of opioid type drugs with any other, or nondependent opioid abuse, iden fied by any of the following ICD‐9‐CM codes in any of the diagnosis fields: 304 (.00‐.02, .70‐.72), 305 (.50‐.52). 43 In the hospital discharge dataset, drug overdoses due to the effect of opiates and related narco cs were iden fied as records with any of the ICD‐9‐CM code 965(.00‐.09) in any of the diagnosis fields. Viral hepa s cases we iden fied by ICD‐9‐CM code 070 in any of the diagnosis fields. Neonatal Abs nence Syndrome (NAS) is a drug withdrawal syndrome in a newborn that is caused by the mother’s drug abuse during pregnancy. Hospitaliza ons involving drug withdrawal syndrome in a new‐
born are iden fied by the ICD‐9‐CM code 779.5 listed in any of the diagnosis fields. A sec on on NAS hospi‐
taliza ons was added to this report to describe another aspect and burden of drug abuse and addic on in the Commonwealth. References:
1. Consensus Recommenda ons for Na onal and State Poisoning Surveillance, The Safe States Alliance, At‐
lanta, GA, April 2012. 2. Bunn TL, Slavova S, Drug Overdose Morbidity and Mortality in Kentucky, 2000‐2010, KIPRC, 2012. 3. Xiang Y, Zhao W, Xiang H, Smith GA. ED Visits for Drug‐related Poisoning in the United States, 2007. Am J Emerg Med. 2012 Feb: 30(2):293‐301. 44